Memorandum by Affinity
AFFINITY (formerly the British Evangelical Council,
which was founded in 1952) is a network of evangelical Christian
denominations, church groupings and independent causes. It is
probably the largest association of exclusively Bible-centred
churches in the United Kingdom, representing approximately 1,200
congregations.
1. OUR INITIAL
RESPONSE
We are disappointed to see the reappearance
of this Bill, an earlier version of which, as the Patient (Assisted
Dying) Bill, was defeated in the House of Lords in June 2003.
Nevertheless, we recognise that there is a minority
of people, plus a few organisations, who are persistently seeking
to change the current legal safeguards and introduce some forms
of euthanasia into the United Kingdom.
2. OUR BIOETHICAL
PRINCIPLES
The best responses to any bioethical issue are
based upon robust principles. Without such principles, responses
inevitably degenerate into feeble subjectivity and utilitarianism.
In the context of this Submission, our response is based on five
principles,
2.1 All human beings are made in the image
of God (Genesis 1:27). Therefore, all human beings have intrinsic
dignity and value.
2.2 It is God who gives (Ecclesiastes 5:18),
sustains (Psalm 54:4), and takes human life (1 Samuel 2:6). Therefore,
to choose, or engineer, or bring about death, whether our own,
or someone else's, without divine sanction, is to usurp God's
prerogative (Psalm 104:29).
2.3 Since human life is a gift it involves
stewardship, not ownership (Romans 14:12; 1 Peter 3:7). Therefore,
sentiments such as, "It's my body, I shall do as I please
with it", display excesses of personal autonomy that are
entirely misplaced and unacceptable.
2.4 Innocent human life is not to be taken
(Genesis 9:6). The Sixth Commandment (Exodus 20:13) reinforces
this principle. Therefore, to destroy innocent human life is an
offence against God's holy law.
2.5 All human life demands special care (Matthew
7:12), particularly those who are weak and vulnerable (James 1:27;
Zechariah 7:8-10). Therefore, such innocent lives are to be protected,
not plundered.
3. OUR BIOETHICAL
CONSEQUENCES
Based upon these principles of historic, orthodox,
biblical Christianity, which are undeniably honourable, wholesome
and beneficial, we,
3.1 Seek to uphold and promote the utmost
respect for all human life, from fertilisation until natural death.
3.2 Are opposed to the deliberate taking
of innocent human life, at any of its stages.
3.3 Are opposed to all forms of euthanasia,
whether it is carried out on the newborn because of some genetic
disorder, whether the patient is elderly and judged to have a
life not worthy to be lived, or whether it is defined in terms
of deliberate acts or deliberate omissions. If the intent is to
kill the patient, it is wrong. Such actions are callous and unworthy
of any decent society.
3.4 Are especially concerned by the current
pressure to legalise some forms of euthanasia, particularly for
the elderly, who are seriously or terminally ill. We regard this
as a perilous slippery slope—voluntary euthanasia will undoubtedly
open the door to involuntary euthanasia, as has occurred in the
Netherlands (see, John Keown (1995). Euthanasia Examined, Cambridge
University Press, pp. 261-296).
3.5 Are also concerned about other issues
associated with euthanasia, such as, the use of "quality
of life" assessments and "living wills". The former
tend to be too subjective and hedonistic, while the latter are
inappropriate and only serve to encourage a climate of medically-assisted
suicide.
4. OUR OPPOSITION
TO THIS
BILL
This Bill is a truly awful piece of proposed
legislation. We are totally opposed to it, in both principle and
in consequence. Some of our more important observations and objections
are listed here:
4.1 The Bill is shocking to read—it
sends a chill through the reader. Its ethos is contrary to all
good medical ethics and practice. In particular, it is contrary
to Hippocratic-Christian medicine, which, for over 2000 years,
has specifically forbidden doctors to assist in deliberately bringing
about the death of patients—"do the patient no harm"
has been its enduring maxim. Noncompliant doctors have rightly,
throughout the ages, been regarded as renegades.
4.2 If the Bill were to become law it would
forever redefine, and hence, destroy the historic role of doctors
and the whole healthcare profession as compassionate carers and
life preservers. It would undoubtedly lead to the greater corruption
of medicine. Not only would the illustrious record of medicine
be abrogated, but also the crucial doctor-patient relationship
of trust would be eroded, and the vulnerable would become fearful
of even entering healthcare facilities.
4.3 The legalisation of any form of euthanasia,
including assisted suicide, as envisaged in this Bill, would require
that such procedures become "management options", to
be discussed with all seriously-ill and terminally-ill patients,
who, because of their very vulnerability, could easily be pressurised
into making inappropriate decisions. The subtle power of doctors
should not be underestimated. Patients would become anxious and
fearful of being burdensome, and thus "a duty to die"
would be engendered.
4.4 The Bill would be unworkable. Some of
the safeguards, such as definitions of "terminal illness",
"within a few months" (p. 2, lines 23, 27) and "made
voluntarily" (p. 3, line 8) are notoriously impossible to
define and predict. They are subjective. Pro-euthanasia healthcare
workers will simply ride roughshod over such supposedly protective
measures. Furthermore, the history of medical bioethics demonstrates
that once a permissive law has been enacted, its originally tight
boundaries are soon expanded—consider, for example, the
initial provisions and expectations of the 1967 Abortion Act.
4.5 The wording of the Bill provides huge
scope for confusion. For example, the stark phrase, ". .
. the patient wishes to be assisted to die" (p. 2, lines
43-44), could be interpreted as helping the patient to die well,
as in good palliative care (of which we would approve), but we
fear that its intended meaning is that of bringing about death
prematurely (of which we disapprove). Similarly, the term "suffering
unbearably" (p. 2, line 48) may be true of a patient on one
day, or week, or month, but may not apply at a later day or period.
It is well known that news of a poor prognosis can have a significantly
depressing effect upon a patient (and relatives and carers), yet
this can be temporary and often, maybe, weeks later, buoyancy
can return.
4.6 The Bill states that the patient must
be informed of "the alternatives" (p. 3, line 5), including
palliative care. This is insufficient and belittles the ways in
which palliative care has transformed dying and death in recent
years. Palliative care, which is simply the application of good
medicine at the end of life, needs to be experienced, not merely
discussed.
4.7 In addition to corrupting the medical
profession, the Bill also insists that members of the legal profession
are to be drafted in as collaborators (p. 3, line 38). Furthermore,
the involvement and potential trauma for those who act as the
"other witness" (p. 4, line 1), in terms of future regrets,
doubts and mistakes, will be too great a burden for most people
to bear.
4.8 The Bill allows (p. 4, lines 25-29) for
the so-called declarations to be revoked. But once signed, patients
are sending a signal, albeit, perhaps unintentionally, to the
healthcare team that they are requesting less than the best future
medical care and treatment—a psychological barrier will
have been irrevocably breached. And with what urgency will doctors
inform their patients of their rights of revocation? A pro-euthanasia
doctor would inevitably be lax in this area. And how will patients,
judged to be on the borders of incompetence and therefore frequently
confused, revoke their declarations? These alleged safeguards
are illusory.
4.9 The Bill allows for conscientious objection
(p. 4, lines 30-43), but what is the point of such a waiver, if
the morally-sensitive doctor has to refer the patient "without
delay" (p. 4, line 37) to a pro-euthanasia doctor? And what
if the ethos of the hospital is anti-euthanasia and one cannot
be found? And will some hospitals become centres of excellence
for the training and implementation of euthanasia to which patients
will be transported? Perish the thought!
4.10 The Bill asserts that any healthcare
professional who assists a patient to die will not have breached
"any professional oath or affirmation" (p. 5, line 22).
This is rank hypocrisy. What about the Hippocratic Oath, or the
Declaration of Geneva? Twenty-five years ago, Thomas Beauchamp
and James Childress (1979) warned in their seminal book, Principles
of Biomedical Ethics (Oxford University Press, p. 113), that,
"Rules against killing in a moral code are not isolated moral
principles; they are threads in a fabric of rules that support
respect for human life. The more threads we remove, the weaker
the fabric becomes." This Bill would shred that fabric.
4.11 The Bill describes the lethal chemical(s)
used to bring about the death of the patient as "medication"
(p. 6, line 19). This is a deplorable misnomer and only fuels
the argument that the Bill, and indeed, the whole issue of euthanasia,
is unnatural, deceitful and offensive.
4.12 The Bill seeks to establish a monitoring
commission in the hope that all cases of euthanasia will be documented
and filed (p. 6, line 20). This, on the evidence from the Netherlands,
will be a vain hope. There, such reporting increased from 30 per
cent to 41 per cent by 1996 but, based on the latest 2001 figures,
is still only 54 per cent. In other words, the administration
and monitoring of Dutch euthanasia, in spite of their professed
"strict" and "precise" guidelines, remains
a shambles.
4.13 The Bill includes (p. 6, line 22) the
phrase "an attempt" to assist to die. Is this a tacit
recognition that assisted suicides are neither always successful,
nor what are purported to be "deaths with dignity"?
The Select Committee will no doubt be aware of the shocking account
of the Dutch experience, reported by Groenewoud et al. (New England
Journal of Medicine (2000) 342: 551-6), which showed that a quarter
of doctor-assisted suicides in the Netherlands were botched, and
that instead of merely "assisting", nearly 20 per cent
of doctors had to act decisively to actually kill their patients.
When such disasters occur, would the Bill allow doctors to cut
the throats of their patients? And if not, why not, because the
doctor's intention would have consistently been to kill the patient?
It is so obvious—the practice of assisted suicide always
leads to full-blown euthanasia.
4.14 Section 15 of the Bill (p. 7, lines
3-6) is wholly unnecessary and disingenuous. It merely serves
to unnerve the general public about end-of-life issues. Any good
doctor will already be prescribing and administering the appropriate
drugs, such as analgesics and sedatives, to relieve pain and distress—no
change in the current law is required.
4.15 We recognise that the "greying"
of the population has increased the financial and personal costs
of caring for the elderly. The economic arguments in favour of
euthanasia are unassailable. The utilitarian says, "Why should
we care, when it's cheaper to kill?" If euthanasia were to
become public policy, the financial savings, and the freeing up
of other resources within the NHS, would be huge. But so would
the moral cost. The Bill would have a profoundly negative effect
upon research and development into proper care—legalised
euthanasia drives out palliative medicine. Instead of regarding
the elderly and terminally ill as costly "bed-blockers",
and therefore expendable, we should be investigating and funding
procedures and facilities to ensure that "their last days
are not lost days". No person has a life unworthy to be lived.
To enable such patients to die well is not only the application
of good Hippocratic-Christian medicine, but it is the fitting
end of a person's life, and a proper closure for the bereaved
family. Euthanasia, of any sort, is counter to these civilized
and important end-of-life events.
5. OUR CONCLUSIONS
5.1 The Christian gospel is the message of
hope. We believe that in this life all human beings have the opportunity
to be reconciled to their God and so live and die well. The people
of God are entrusted with this gospel to demonstrate to all people
how to live well and how to die well. Christians must therefore
be in the vanguard by showing compassion towards all those who
suffer, including the disabled and the dying.
5.2 We call upon all those in authority to
oppose every form of euthanasia and instead to encourage legislation,
resources and action that will support and cherish human physical,
mental and spiritual life, at all its stages.
5.3 We are glad to learn that the Bill is
opposed by many groupings within the medical profession, including
the BMA and the Royal College of Nursing, and many disability
rights groups, such as Disability Awareness in Action, and other
organisations like, Age Concern and Help the Aged. We join them
in our steadfast opposition to this Bill.
5.4 The end of life is always a complex and
difficult time for patient, carers and families. It is the last
of life's great endeavours. The dying deserve the best care and
attention. Medical treatment should be provided when it will be
beneficial, and palliative care when it will not. Euthanasia must
never be regarded as proper medical treatment. Killing the patient
can never, ever be the right answer.
We welcome this opportunity to submit this response
to the Select Committee on behalf of our constituency.
We sincerely hope that the Select Committee
will conclude, as its forerunner, the Select Committee on Medical
Ethics, did in 1994, not ". . . to weaken society's prohibition
of intentional killing." And that this Committee will again
recognise that, "It would be next to impossible to ensure
that all acts of euthanasia were truly voluntary, and that any
liberalisation of the law was not abused."
We trust that the Select Committee will resolutely
oppose this Bill, and any other attempts to relax our current
laws regarding the issues of dying and death.
20 August 2004.
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